Ovarian teratomas are a group of tumors derived from germ cells, most of them are benign, a few can become malignant or can be malignant from the beginning. Mature teratomas are malignant and mature teratomas are benign. Teratomas contain sebaceous glands, hair, bone or teeth, and are prone to ovarian cystic tibial torsion. It can become malignant after menopause. Therefore, surgical treatment is required. The principle of surgery is to remove the teratoma and preserve the affected ovary. The surgical approach can be open, laparoscopic or vaginal. The laparoscopic approach is preferred because of the high risk of injury and because the patients are mostly young women, mostly unmarried or infertile. The problem with laparoscopic surgery is that it is expensive, mostly around 10-20,000, and if the teratoma ruptures during surgery, it can cause intra-abdominal contamination and postoperative adhesions causing abdominal pain and other complications. In case of immature teratoma, it can lead to abdominal implantation. Transvaginal surgery is a procedure performed through a natural orifice without any scarring. However, it requires a high level of skill on the part of the surgeon.